No downside to gaining health care for 200,000 or more; 30,000 jobs and millions of dollars for hospitals from expansion of Medicaid.

Gov. Terry McAuliffe is right to make expansion of health coverage part of the budget process.

Any measure that would create 30,000 jobs, that could save $1 billion in the state budget over 12 years, that could provide health insurance for 35,000 people who don’t have it in Fairfax County alone, that is supported overwhelmingly by the business community and hospitals, actually deserves to be a part of the budget. As many as 400,000 people in Virginia currently without health insurance could be covered.

Under the Affordable Care Act, if states opt in to the expansion of Medicaid, Federal dollars would pay the costs for five years to cover people with incomes up to 138 percent of poverty, $15,856 for an individual or $26,951 for a family of three in 2013. After five years, federal dollars would still cover 90 percent.

Under the Affordable Care Act, people with incomes 100 - 400 percent of poverty qualify for subsidies on their health insurance premiums when they purchase coverage through a Marketplace. The amount of the subsidy, provided via tax credit, is based on income and the cost of insurance, and are only available to people who are not eligible for other coverage, such as Medicaid/CHIP, Medicare, or employer coverage, and who are citizens or lawfully-present immigrants. Because the Affordable Care Act envisioned low-income people receiving coverage through Medicaid, people below poverty are not eligible for Marketplace subsidies. At least 190,000, and as many as 400,000 adults in Virginia fall into the coverage gap because they don’t qualify for Medicaid under Virginia’s rules, among the most stringent in the nation, but earn less than the poverty rate, so not enough to qualify for subsidies. [Source: Kaiser Family Foundation]

Elections have consequences. McAuliffe made expansion of Medicaid a key element of his campaign, and Virginia voters chose McAuliffe. The Virginia Senate approved a plan to expand health coverage using Medicaid dollars to purchase private health insurance.

There must be a way forward that doesn’t involve stifling economic growth and the health of poor Virginians.